Woods & Water Medical

600 N. 21st St.

Superior, WI 54880
715-394-6677
jclancy@WWMC.com

Patient Rights
Woods & Water Medical Center wants every patient to receive the best possible care. To that end, we want you to
know what your rights are. For example, it is your right to receive care without discrimination, have your family
involved, participate in planning your medical treatment, complete an advance directive outlining your healthcare
wishes and have your healthcare kept confidential. Specific rights are listed below.
As a patient at Woods & Water Medical Center, I, or my legally authorized representative, have the right to:
 Receive care without discrimination due to  Receive evaluation and provisions of
my race, creed, color, national origin, protective services.
ancestry, religion, sex, sexual orientation,  Designate who is permitted to visit me during
marital status, age, newborn status, my hospitalization.
handicap, or source of payment.  Receive care and treatment that respects my
 Have my family and physician notified values, beliefs, and life philosophy.
promptly of my admission and have my  Address ethical questions that arise in my
family participate in my care decisions. healthcare.
 Know the name of the physician or other  Receive emotional and spiritual support for
practitioner who has primary responsibility my family and me.
for my care and know the identity and  Complete an advance directive outlining my
professional status of the people caring for wishes regarding my healthcare should I
me. become unable to express my wishes. This
 Receive from my physician, in terms I can may include my wishes regarding organ and
understand, current information about my tissue donation.
diagnosis, treatment, and prognosis.  Refuse treatment to the extent permitted by
 Receive from my physician, except in law and be informed of the medical
emergencies, information that allows me to consequences of my actions.
give informed consent before beginning any  Be informed of the need for, alternative to,
procedure or treatment. and acceptance by another facility when
 Participate in the planning of my medical transfer to that facility is planned.
treatment and to decline to participate in  Have all communications and records
experimental research pertaining to my healthcare kept confidential.
 Receive care for symptoms that will respond  Have access to my medical record within a
to treatment, even if they are not related to reasonable timeframe.
my primary healthcare condition.  Examine and receive an explanation of my bill
 Receive evaluation and management of pain. regardless of the source of payment and
 Receive considerate and respectful care in a receive information regarding financial
safe and private environment free of neglect, assistance.
harassment and abuse.  Receive information regarding the
 Be free from restraints of any form that are relationship of Woods & Water Medical
not medically necessary or are used as a Center to other healthcare or educational
means of coercion, discipline, convenience, institutions involved in my care.
or retaliation by staff.  Receive complete language translation, free
 Be free from seclusion and restraints of any of charge.
form that are not necessary for emergency
behavior management or are imposed as a
means of coercion, discipline, convenience,
or retaliation by staff.
I have read and understood my rights.

Patient Signature Date

4/18/2021